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Verification of Feeding Tube Placement 2 Expected Practice  Use a variety of methods to predict location during tube insertion  Signs of respiratory distress  Capnography if available  Visual characteristics of aspiration  Ausculatory and water bubbling are unreliable

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3 Expected Practice  Obtain radiographic confirmation of any blindly inserted tube  Radiograph should visualize the entire course of the tube  Should be read by a radiologist  Mark and document the tube’s exit site immediately after confirmation of correct placement Verification of Feeding Tube Placement

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5 Scope and Impact  Blind placement of a feeding tube can cause serious and even fatal complications.  Even a small percentage of such complications can affect a significant number of people.  Styleted small-bore tubes are most often associated with complications, however, large-bore unstyleted tubes are not without risk. Nasogastric feeding tubes were malpositioned in 1.3% to 2.4% of all insertions; malpositions resulted in pneumonia.  Critically ill patients often have multiple risk factors for airway misplacements; among these are a decreased level of consciousness, altered gag reflex, presence of an endotracheal tube, and multiple insertion feeding tubes may be malpositioned in the brain.  Risk for aspiration is greatly increased when a feeding tube’s ports end in the esophagus.  Complications related to malpositioned feeding tubes can be minimized by explicit policies and procedures for feeding tube insertions. Verification of Feeding Tube Placement

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6 Bedside Methods to Determine Placement  Signs of respiratory distress  Capnography  pH and Appearance of Aspirate  Listening over the epigastrum for air insufflated through tube is not reliable Verification of Feeding Tube Placement